后路腰椎间盘镜手术治疗腰椎间盘突出症失误剖析.docVIP

后路腰椎间盘镜手术治疗腰椎间盘突出症失误剖析 　　 [摘要] 目的:分析后路第二代腰椎间盘镜手术治疗腰椎间盘突出症失误的主要因素。方法：通过对临床资料和X线片、CT、MR等影响资料的分析,回顾性分析126例后路腰椎间盘镜手术4例失误病例。结果：4例中1例术前诊断不全面,1例高龄、伴椎间盘钙化,椎管狭窄,适应证选择不当。1例术中椎管狭窄神经通道减压不充分,1例双间隙突出,对髓核摘除不够,对突出间隙神经根管外口减压不够。结论：腰椎间盘突出症后路椎间盘镜手术失误的主要原因是手术适应证选择不当和手术技术失误。 　　［关键词］ 腰椎间盘突出症； 椎间盘镜； 手术治疗； 失误 　　［中图分类号］ R681.53 ［文献标识码］ A ［文章编号］ 1671-7256(2011)02-0159-03 　　doi:10.3969/j.issn.1671-7256.2011．02.011 　　Lapses of microendoscopic discectomy for lumbar disc herniation 　　SUN Chang-gen, WANG Jian 　　(Department of Orthopaedics, People?s Hospital of Jianhu County, Jianhu 224700, China) 　　［Abstract］ Objective: To describe and discuss the causes for lapsus in the primary operation for lumbar disc herniation using METRx Ⅱ. Method: Clinical data and image data of 126 patients(76 men, 50 female) who underwent posterior microendoscopic discectomy(MED) were collected for retrospective study. 4 patients with unsatisfied curative effect were selected and analysised. Results: The reasons accounted for the lapses of primary MED in 4 cases were found as follows: 1 case was misdiagnosed, 1 was elderly with calcification of posterior margin of lumbar disc, 1 was inappropriately indicated,and 1 had double-levels lumbar disc herniation and incomplete decompression. Conclusion: The main lapses of MED are inappropriate surgical indication and inexperience surgical technology. 　　［Key words］ lumbar disc herniation; microendoscopy; surgical therapy; lapsus 　　 　　2002年10月至2006年02月我科行腰椎间盘突出症后路椎间盘镜手术共126例,患者入院后均行X线片及CT检查,绝大多数患者行腰椎过伸、过屈位X线检查,部分行MR检查、脊髓造影检查。现结合临床及影像学检查资料,对其少数手术失误的主要因素进行分析。 　　1 临床资料 　　1.1 一般资料 　　本组126例中,男76例,女50例;年龄22～69岁,平均36岁。入院时间为发病后3个月～8年；腰椎间盘突出部位L4/L5 68例,L5/S1 53例,L4/L5、L5/S1 5例；腰痛伴下肢痛106例,单纯下肢痛18例,单纯腰痛2例；直腿抬高试验阳性单侧110例，双肢16例。 　　1.2 再次入院手术或术后疗效不满意原因 　　主要原因是患者腰腿痛症状没有得到明显的缓解,个别病例症状稍微缓解后时间不长症状又复加重,腰痛、下肢痛、直腿抬高试验(+),伸?、伸趾障碍。其中有1例症状较严重,伴有腰椎明显不稳、椎管狭窄表现,X线摄片、CT、MR检查显示：腰椎不稳,侧隐窝狭窄,影像学证明首次手术存在失误,而必须再做侧隐窝扩大,神经根管减压、腰椎后路融合术。1例术后1年症状没有缓解且加重,影响工作和生活,CT及MRI示腰椎间盘突出明显,系第1次手术髓核摘除不够及神经根管减压也不够,进行